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Antidepressants linked to higher risk of stroke, death in women after menopause

December 14, 2009 | 5:46
pm

Post-menopausal women taking antidepressants are at higher risk of suffering a stroke or of dying of any cause than are those who do not take such medications, a study released Monday found.

The authors of the study, published in theArchives of Internal Medicine, called the increased risk a woman faces modest. But they noted that since post-menopausal women make up the largest segment of patients in the United States on antidepressants, the resulting increases in strokes and deaths across the country could be significant.

The findings emerged from the federally funded Women's Health Initiative, one of the nation's largest and most comprehensive studies of women's health. The study followed 136,293 post-menopausal women, age 50 to 79, for just under six years. During that time, 5,496 developed depression and were treated with antidepressant medication.

During the span of follow-up, the women on antidepressants were 45% more likely than those not on such medication to have a stroke, and 32% more likely to die of any cause. Hemorrhagic strokes (bleeding in the brain, as opposed to ischemic strokes caused by a blockage) were more likely among the women on depression medication--the result, the authors surmised, of the anti-clotting effect of selective serotonin reuptake inhibitors, or SSRIs, which are most frequently prescribed for depression. But they found no discernible difference between the outcomes of women on the older generation of antidepressants--the tricyclics--and those on the newer-generation SSRIs.

For a woman beyond her child-bearing years contemplating whether to treat her depression with medication, that added risk is very slight: In any given year, such a woman off medication has a 0.3% probability of suffering a stroke. On such medication, her yearly risk of such an event rises to 0.43%. The authors found no difference in a woman's risk of coronary heart disease--fatal or non-fatal heart attacks--whether she is on or off an antidepressant medication.

The finding underscores what women have come to learn from a wide range of studies, including several that have emerged from the Women's Health Initiative: It's important to know whether you are at high or low risk of something like stroke before allowing a study like this to sway a decision to take medication for depression, and that's a conversation to be had with a physician who knows your medical history. And if you are a post-menopausal woman on antidepressants, it underscores the importance of lowering those risks you do have for stroke--by treating high blood pressure, maintaining a healthy weight, exercising and keeping stress under control.